Antifibrotics and lung transplantation: A Spanish multicentre case‐controlled study

Abstract

Background and objective Antifibrotic drugs are the standard treatments for patients with idiopathic pulmonary fibrosis (IPF). This study aims to assess the safety of antifibrotic treatment in IPF patients undergoing lung transplantation. Methods Patients with a diagnosis of IPF who received a lung transplant between January 2015 and June 2019 at four Spanish hospitals specialized in lung transplantation were retrospectively recruited. Cases were defined as patients receiving antifibrotic treatments at time of transplant. Each case was matched with a control who did not receive antifibrotic treatment. Results A total of 164 patients were included in the study cohort (103 cases and 61 controls). There were no statistically significant differences between the cases and controls in any of the items studied related to transplantation except the time until the appearance of chest wall dehiscence: although there were no differences in the incidence of wall dehiscence in either group (12.3% vs. 13.7%; p = 0.318), the patients on antifibrotic drugs experienced it earlier (21 days [IQR = 12.5–41.5] vs. 63 days [IQR = 46.75–152.25]; p = 0.012). There were no differences in overall post‐transplant survival between the two groups (p = 0.698) or in conditional survival at 30 days, 90 days, 3 years or 5 years. However, 1 year survival was significantly greater among controls (80.6% vs. 93.3%; p = 0.028). Conclusion There was evidence that chest wall dehiscences appeared earlier post‐transplant in patients using antifibrotics, even though this factor did not significantly impact survival.

Contemporary Concise Review 2022: Interstitial lung disease

“…However, in a single centre analysis patients undergoing transplant during AE‐ILD had similar 1‐year survival to those with stable disease suggesting that emergency lung transplantation may suitable for selected patients 79 . It may be beneficial to withhold antifibrotic treatment at the time of transplantation, as chest wall dehiscence was seen earlier and 1‐year survival was worse in patients on treatment, although there was no significant difference in overall incidence of dehiscence or survival at other time points (30 days, 90 days and 3 or 5 years) 80 …”

“…79 It may be beneficial to withhold antifibrotic treatment at the time of transplantation, as chest wall dehiscence was seen earlier and 1-year survival was worse in patients on treatment, although there was no significant difference in overall incidence of dehiscence or survival at other time points (30 days, 90 days and 3 or 5 years). 80…”

Effect of antifibrotic agents on postoperative complications after lung transplantation for idiopathic pulmonary fibrosis

“…Our results are consistent with previous findings. [12][13][14][15][16][17][18][19]22,26,28,29 None of the previous studies highlighted an increase in complications. Besides the small number of patients receiving AFA (as in our study) and the fact the type of AFA was pirfenidone in most cases, another limitation of these previous studies focusing on complications potentially related to AFAs was the small overall event numbers.…”

“…To date, the literature on post-transplant complications related to AFAs is limited. [12][13][14][15][16] Available studies mostly concern small numbers of patients with low event rates. One of the largest studies, 13 performed in Australia, analysed 226 IPF patients who underwent LTx; 40 patients were under AFA treatment at the time of LTx, but only 11 were receiving nintedanib.…”

Anti-fibrotic therapy and lung transplant outcomes in patients with idiopathic pulmonary fibrosis

“… 24 In a multi-center Spanish study of 164 patients with IPF, there were no differences in the incidence of post-transplant complications between patients who were versus were not taking anti-fibrotic therapy at the time of transplant, although chest wall dehiscences appeared earlier in patients who had used anti-fibrotic drugs. 27 …”